Assessing Virtual Versus In-Person Experiential Learning in Medical Student Pediatric Clerkship Training Andrew Berry, Andrew Wigger, Karilynn Craig, Dr. Brock Blankenship, Dr. Jennifer Gibson, Center for Experiential Learning, Quillen College of Medicine, East Tennessee State University, Johnson City, TN. Simulation and experiential training have been incorporated into medical school training for decades. While there are many ways to accomplish experiential-based learning, many faculty and students feel Socratic learning styles provide the best learning experience. As medical students had just finished a predominantly virtual preclinical year due to the COVID-19 pandemic, our research team was interested in understanding students’ perceptions of virtual and in-person experiential learning activities. The primary goal of this study is to compare medical students’ perceptions of the quality and value of in-person versus virtual experiential learning during their pediatric clerkship. Secondary measures of this study examine the differences regarding the retention of case information presented, the clinical relevance of the pediatric cases discussed, and the likelihood that students will attend similar future sessions. Our team hypothesized that students would perceive in-person sessions as more valuable and meaningful to their medical education. One academic year of medical students who participated in two experiential learning encounters during their pediatric clerkship was assessed. Each encounter involved a series of approximately ten patient cases over two hours; one encounter was done in person, and the other was done virtually. Each case was then discussed using a Socratic format; faculty would ask questions and engage students individually, assessing their decision-making capability (including differential diagnosis, treatment plans, and dispositions). Data was collected by a survey administered after both encounters, each with the same questions. Students generally felt the virtual format for this type of training was as well received as the in-person format (56% vs. 52.2% for excellent value ratings, respectively). Similarly, 43.5% of students reported that the in-person cases greatly improved their retention, while 40% said the virtual cases improved their retention of educational material to the same degree. The in-person experiences were reported as being extremely clinically relevant by 56.5% of students, while the virtual cases were perceived as extremely relevant by 48% of respondents. Lastly, survey data showed that 47.8% of respondents said they would very likely attend similar future in-person sessions (compared to 44% for similar virtual events). Our team feels that the results of this study demonstrate that utilizing a Socratic Model of teaching in experiential learning has excellent value, and high-quality training can be accomplished virtually, even during times of potential virtual fatigue. These findings are important as our results show that experiential learning can be adapted, yet still beneficial, when in-person activities cannot take place, such as what we encountered during the COVID-19 pandemic.

Most cases of Van der Woude syndrome are caused by a mutation to interferon regulatory factor 6 on chromosome 1. Turner syndrome is caused by complete or partial absence of the second sex chromosome in girls. We describe a unique case of the two syndromes occurring concurrently though apparently independently in a girl with Van der Woude syndrome diagnosed at birth and Turner syndrome at 14 years 9 months. Short stature was initially misattributed to Van der Woude syndrome and pituitary insufficiency associated with clefts before correctly diagnosing Turner syndrome. We discuss the prevalence of delayed diagnosis of Turner syndrome, the rarity of reports of concurrent autosomal chromosome mutation and sex chromosome deletion, as well as the need to consider the diagnosis of Turner syndrome in all girls with short stature regardless of prior medical history.

Kinder Tools was developed as a Response to Intervention approach (RTI) to help students in kindergarten improve and develop their fine motor and visual motor perceptual skills within the first three months of entering kindergarten. Some students enter kindergarten ready to learn, while other students struggle with skill development and learning the curriculum. There are a variety factors that could impact a student’s ability to learn such as lack of exposure, disabilities, and culture/socioeconomic status. This program will provide specific strategies and activities that will help to improve the necessary skill development that is required to access the kindergarten curriculum. The occupational therapist will provide consultation services to assist teachers to implement modifications and strategies to help students who are struggling with tasks. Two out of four kindergarten classrooms will participate in the initial program, while the other two classes will serve as the control group. All students fine motor and visual motor perceptual skills will be assessed pre and post program completion. The hope is that students participating with use of the Tools will demonstrate significant improvement in fine motor and visual motor perceptual skills, resulting in decreased need (or no need) for direct occupational therapy (OT) services and increased ability to access the curriculum within the general education setting.

BACKGROUND: Chronic illness in children is highly disruptive to both the affected child and their parent(s). Recent literature largely supports the impact of psychosocial factors on the onset and progression of IBD. Our study aims to investigate how psychosocial factors involved in parental and child coping, such as anxiety or depression, may predict the clinical and psychological outcomes of children with newly diagnosed IBD. METHODS: We recruited and administered questionnaires to parents and children (aged 9-17) with newly diagnosed IBD. Questionnaires were administered at enrollment and at follow-up visits about one year later. The children completed four questionnaires, including IMPACT-III (measure for quality of life), SCARED (screens for anxiety), and CDI and PHQ-9 (screens for depression). The parents completed three questionnaires, including HADS (screens for anxiety and depression), PIP (assesses the burden of parental stress related to caring for an ill child), and a healthcare utilization survey (quantifies the need for medical support). Clinical data were extracted from the Boston Children’s Hospital’s electronic medical records to assess clinical outcomes. RESULTS: We recruited a total of 86 parent/child pairs. Of the 31% of children screening positive for anxiety, 61% had parents that also screened positive for anxiety (p = 0.007). However, the same relationship was not observed for depressed children and their parents. Children with anxious parents reported a significantly worse quality of life than children with non-anxious parents (119.61 vs. 137.33; p < 0.001). Although the same mean differences were not observed for children with depressed parents, there was an association between parents that scored higher for depression and children who scored lower for quality of life (r = -0.287; p < 0.010). Quality of life scores were significantly lower in children above 12 years old than in children under 12 years old (126.6 vs 137.67; p = 0.021). Furthermore, children with worse disease severity (assessed by PUCAI or PCDAI scores) also reported worse quality of life. No significant associations were observed between disease severity and parental anxiety/depression or between disease severity and child anxiety/depression. Greater healthcare utilization was significantly correlated with greater parental anxiety (r = 0.269; p = 0.017) and greater parental depression scores (r = 0.324; p = 0.004). Over a one-year period, paired survey data revealed decreased parental stress, healthcare utilization, and child anxiety. There were no significant differences in parental anxiety, parental depression, or child depression, while a significant improvement was observed in child quality of life over a one-year period. CONCLUSIONS: Greater parental anxiety, depression, and stress correlated with worse quality of life in children with newly diagnosed IBD. Similarly, higher anxiety and depression scores in children were associated with decreased quality of life. Interestingly, this association was not seen for disease severity. While this may indicate a stronger relationship with parent and child coping and a child’s behavioral outcomes rather than the child’s clinical outcome, additional studies are needed, as the PUCAI and PCDAI scores for disease severity were the only measurements for clinical outcomes. In addition, while we identified significant findings at one year, the study sample size for those who completed follow-up was relatively small. Larger studies are necessary to further investigate the longitudinal outcomes of coping in pediatric IBD. Overall, our data supports a more holistic approach to addressing the behavioral, emotional, and physical needs of both parents and children with newly diagnosed pediatric IBD.

Background: Red cell transfusions can lead to alloimmunization; however, pediatric alloimmunization frequency has not been well studied, and it may vary among diagnostic subgroups. Subgroups such as pediatric hematology/oncology patients require numerous transfusions during chemotherapy, but the immunosuppressive effect of chemotherapy on alloimmunization is unknown. One study demonstrated reduction in IgM and IgG in pediatric leukemia patients (Martín Ibáñez 2003); hence, one could hypothesize that chemotherapy suppresses alloimmunization. Objectives: This study aimed to: 1) describe alloimmunization frequency and antibody specificities in transfused pediatric patients; and 2) determine if chemotherapy affects the frequency of alloimmunization. Methods: A retrospective cohort study of pediatric patients (transfused between April 2002 and November 2011 at Hamilton Health Sciences) was performed. Data were extracted from 3 sources: a blood utilization database; the Laboratory Information System; and chart reviews. The chemotherapy treatment group included pediatric hematology/oncology patients stratified by HSCT status and diagnosis; control cohort included other pediatric patients not diagnosed with cancer. Control patients with hemoglobinopathies were analyzed separately due to increased alloimmunization. Alloimmunization was defined as clinically significant IgG alloantibody formation. Results: There were 1273 patients in the study: 949 in control group; 324 in study group. Alloimmunization was 1.6% overall: 0.6% (95% CI: 0, 1.47) in study group; 1.3% (95% CI: 0.58, 2.06) in control group. The association between chemotherapy and alloimmunization was not significant (p value = 0.38 Fisher’s exact test; OR 0.46, 95% CI: 0.10, 2.09). Due to low outcome rate, logistic regression to explore the association was not feasible. Conclusions: This is the first study exploring the frequency of alloimmunization in pediatric patients by diagnosis and the association between chemotherapy and alloimmunization. The frequency of alloimmunization was low and no association between chemotherapy and alloimmunization was observed. Low event rate would have contributed to low power. / Thesis / Master of Science (MSc)

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